SUMMARY Zika virus (ZIKV) is an emerging Flavivirus transmitted by Aedes species mosquitoes, sexual contact, blood transfusions or vertically from mother to fetus. While most ZIKV infections are asymptomatic, infection during pregnancy can result in fetal loss or congenital ZIKV infection with microcephaly or other central nervous system (CNS) damage. The study team hypothesizes that neurobiological, environmental and system factors contribute to deleterious cognitive and reduced social and emotional school readiness in children born to mothers with laboratory confirmed ZIKV PCR positive and possible ZIKV IgM positive infection during pregnancy. The study team expects to improve the knowledge of the full spectrum of outcomes of congenital ZIKV infection during the critical developmental period of early childhood that should translate into better practices in the provision of services and support to families, many of which are disadvantaged. This evidence will be useful for clinicians to identify subtle neuro-developmental and behavioral abnormalities as they manifest and for families to seek early services to improve health and quality of life. The proposed research addresses the specific objective of the National Institute of Minority Health and Health Disparities to improve minority health and reduce health disparities. Aim 1 will track sensory, neurologic, developmental and behavioral outcomes and assess whether the abnormalities identified are permanent or transient or become evident over time from birth to school age. Aim 2 will expand knowledge on how environmental factors influence the outcomes of congenital ZIKV infection and which factors can be considered protective or damaging to implement preventive measures. Aim 3 will assess health equity by evaluating the access and quality of healthcare. The results obtained will help guide best practices aimed at reducing health disparities. The exploration of family dynamics that affect child development will help caregivers and providers assess and implement best practices. The identification of environmental factors will allow timely actions by agencies and the community that could protect against further damage to the developing brain. The team is confident that lessons from health equity can empower families to overcome the limitations posed by their child's congenital anomalies and developmental disabilities and increase awareness of health care providers to remove barriers to access and improve adherence. Adequate health care models will show when and how it is best to intervene while informing policy regarding system's improvements for healthier children.